肉芽腫性乳腺炎膿液棒狀桿菌的檢測及其臨床意義的初步探討
發(fā)布時間：2018-08-31 10:21
【摘要】：研究背景肉芽腫性乳腺炎(GM,Granulomatous mastitis)是一種少見的乳腺良性肉芽腫性病變,常發(fā)生于經(jīng)產(chǎn)育齡期婦女。臨床上以突發(fā)乳腺腫塊、膿腫形成、繼發(fā)竇道和潰瘍等為特征的一類非哺乳期乳腺難治性炎癥,常反復發(fā)作或經(jīng)久不愈[1.2]。近年來,GM病因不明但發(fā)病率逐漸增高,同時也越來越多的研究表明棒狀桿菌感染可能與GM的發(fā)病機理密切相關[3.4]。我院一項最新研究[5]應用宏基因組學方法對膿腫型GM患者的膿液進行細菌學的系統(tǒng)研究,證明棒狀桿菌是GM患者膿液中的優(yōu)勢感染細菌,進一步證實了棒狀桿菌在GM發(fā)病機制中起重要的促進作用。目前,國內(nèi)外GM一線治療方案推薦應用類固醇激素序貫手術治療[6.8]。但對于合并棒狀桿菌感染的GM患者,單純依靠類固醇激素藥物治療并不能使所有患者獲益。臨床上普通血平板對GM患者的膿液進行細菌培養(yǎng)率低,難以指導臨床進一步用藥。文獻報道包含吐溫80的培養(yǎng)媒介有利于棒狀桿菌的培養(yǎng)[9]。另外,細菌PCR檢測方法可進一步提高棒狀桿菌檢測的敏感性。因此,本研究運用包含吐溫80的高脂血平板進行棒狀桿菌的培養(yǎng)以及PCR方法檢測棒狀桿菌,并與傳統(tǒng)的細菌培養(yǎng)方法進行比較,探討改進提高棒狀桿菌檢出率的檢測方法。最后,根據(jù)GM棒狀桿菌的陽性檢測結(jié)果選擇單純抗生素或抗生素聯(lián)合類固醇激素治療,并與臨床常規(guī)的單純類固醇激素治療比較,初步探討GM膿液棒狀桿菌的檢測及其對臨床用藥治療的指導意義。研究目的1、探討改進GM膿液棒狀桿菌檢測方法并提高棒狀桿菌的檢出率;2、探討棒狀桿菌感染對GM患者臨床預后的影響,證明棒狀桿菌在GM發(fā)病機制中起重要作用;3、探討抗生素治療在感染棒狀桿菌的GM患者中的臨床療效并指導臨床用藥方案的制定。研究方法1、通過應用高脂血平板與PCR檢測方法提高棒狀桿菌的檢出率,并通過與普通血平板檢出率的對比,檢測不同方法之間的優(yōu)劣;2、根據(jù)PCR檢測結(jié)果制定GM患者不同的治療方案并進行隨訪,證明抗生素治療對感染棒狀桿菌的GM患者的重要性。研究結(jié)果1、肉芽腫性乳腺炎棒狀桿菌的檢測方法研究:(1)24例膿液樣本分兩個重復:行普通血平板培養(yǎng),陽性率為16.7%;行高脂血平板培養(yǎng),陽性率為50.0%。棒狀桿菌在高脂血平板的細菌培養(yǎng)檢出率顯著提高了33.3%,兩者之間的差異有統(tǒng)計學意義,P=0.014。(2)44例膿液樣本分兩個重復:行高脂血平板培養(yǎng),棒狀桿菌陽性率36.4%,C.K棒狀桿菌陽性率31.2%;行PCR檢測,棒狀桿菌陽性率50.0%,C.K棒狀桿菌陽性率45.5%。兩者之間的差異無統(tǒng)計學意義,P=0.197。2、肉芽腫性乳腺炎棒狀桿菌檢測對臨床用藥的指導意義:(1)86例膿液標本行PCR檢測,棒狀桿菌的陽性率為59.3%,陰性率為40.7%;C.K棒狀桿菌的陽性率為54.7%,陰性率為45.3%。(2)治療感染棒狀桿菌的GM患者的抗生素方案包括短效左氧氟沙星及阿奇霉素、長效抗分枝桿菌三聯(lián)藥物。(3)隨訪42例病例,PCR檢測棒狀桿菌陽性21例,術后復發(fā)率23.5%。三組不同治療方案對感染棒狀桿菌的GM患者之間療效差異有統(tǒng)計學意義,P=0.036。(4)隨訪42例病例,PCR檢測棒狀桿菌陰性21例,術后復發(fā)率16.7%,兩組不同治療方案對無細菌感染的GM患者之間療效差異無統(tǒng)計學意義,P=0.719。結(jié)論高脂血平板細菌培養(yǎng)及PCR檢測方法是可靠、快速的檢測GM患者膿液棒狀桿菌的方法。GM患者及早發(fā)現(xiàn)棒狀桿菌的感染對臨床指導親脂抗生素的應用是有意義的。
[Abstract]:Background Granulomatous mastitis (GM) is a rare benign granulomatous lesion of the breast, often occurring in women of childbearing age. Clinically, it is a refractory inflammation of the non-lactating breast characterized by sudden breast mass, abscess formation, secondary sinus tract and ulcer, often recurring or prolonged. In recent years, the etiology of GM is unknown, but the incidence of GM is gradually increasing. At the same time, more and more studies show that Corynebacterium infection may be closely related to the pathogenesis of GM [3.4]. The dominant infectious bacteria further confirm that Corynebacterium plays an important role in the pathogenesis of GM. At present, sequential surgery with steroids is recommended for the first-line treatment of GM at home and abroad. It is reported that the medium containing Tween 80 is beneficial to the culture of Corynebacterium. In addition, bacterial PCR assay can further improve the sensitivity of Corynebacterium detection. Therefore, the use of Tween 80 in this study is high. Corynebacterium Corynebacterium was cultured on a lipid blood plate and detected by PCR. The method was compared with the traditional culture method to improve the detection rate of corynebacterium. Finally, according to the positive test results of GM corynebacterium, antibiotics or antibiotics combined with steroid hormones were selected and compared with the usual clinical practice. Objective 1. To improve the detection method of Corynebacterium pyogenes and to improve the detection rate of Corynebacterium pyogenes; 2. To explore the influence of Corynebacterium infection on the clinical prognosis of patients with GM and to prove that Corynebacterium pyogenes is in GM. 3. To explore the clinical efficacy of antibiotics in patients with Corynebacterium infection and to guide the formulation of clinical drug regimens. Methods 1. To improve the detection rate of Corynebacterium by high-fat blood plate and PCR, and to detect different methods by comparing with the detection rate of common blood plate. Results 1. Detection of Corynebacterium granulomatosus mastitis: 24 cases of pus samples were divided into two repetitions: normal blood plate culture, the positive rate was 16.7. The positive rate of Corynebacterium was increased by 33.3%. The difference was statistically significant (P = 0.014). (2) 44 pus samples were divided into two repetitions: the positive rate of Corynebacterium Corynebacterium was 36.4% and the positive rate of C.K. Corynebacterium was 31.2%. PCR detection was performed. The positive rate of Corynebacterium was 50.0% and that of C.K was 45.5%. There was no significant difference between them. P=0.197.2. The significance of detection of Corynebacterium granulomatosus for clinical medication was as follows: (1) The positive rate of Corynebacterium was 59.3%, the negative rate was 40.7%, and the positive rate of C.K Corynebacterium was 54.7%. Negative rate was 45.3%. (2) Antibiotic regimens for GM patients infected with Corynebacterium included short-acting levofloxacin and azithromycin, long-acting anti-mycobacterium triple drug. (3) Follow-up of 42 cases, 21 cases were positive for Corynebacterium by PCR, and the recurrence rate was 23.5%. The efficacy of the three regimens was poor among GM patients infected with corynebacterium. P = 0.036. (4) Follow-up 42 cases, PCR detection of Corynebacterium negative 21 cases, postoperative recurrence rate of 16.7%. There was no significant difference between the two groups of different treatments for non-bacterial infection of GM patients, P = 0.719. Conclusion High-fat blood plate bacterial culture and PCR detection method is reliable, rapid detection of GM patients pus club shape. The early detection of Corynebacterium infection in GM patients is of great significance for clinical application of lipophilic antibiotics.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R655.8
本文編號：2214699
[Abstract]:Background Granulomatous mastitis (GM) is a rare benign granulomatous lesion of the breast, often occurring in women of childbearing age. Clinically, it is a refractory inflammation of the non-lactating breast characterized by sudden breast mass, abscess formation, secondary sinus tract and ulcer, often recurring or prolonged. In recent years, the etiology of GM is unknown, but the incidence of GM is gradually increasing. At the same time, more and more studies show that Corynebacterium infection may be closely related to the pathogenesis of GM [3.4]. The dominant infectious bacteria further confirm that Corynebacterium plays an important role in the pathogenesis of GM. At present, sequential surgery with steroids is recommended for the first-line treatment of GM at home and abroad. It is reported that the medium containing Tween 80 is beneficial to the culture of Corynebacterium. In addition, bacterial PCR assay can further improve the sensitivity of Corynebacterium detection. Therefore, the use of Tween 80 in this study is high. Corynebacterium Corynebacterium was cultured on a lipid blood plate and detected by PCR. The method was compared with the traditional culture method to improve the detection rate of corynebacterium. Finally, according to the positive test results of GM corynebacterium, antibiotics or antibiotics combined with steroid hormones were selected and compared with the usual clinical practice. Objective 1. To improve the detection method of Corynebacterium pyogenes and to improve the detection rate of Corynebacterium pyogenes; 2. To explore the influence of Corynebacterium infection on the clinical prognosis of patients with GM and to prove that Corynebacterium pyogenes is in GM. 3. To explore the clinical efficacy of antibiotics in patients with Corynebacterium infection and to guide the formulation of clinical drug regimens. Methods 1. To improve the detection rate of Corynebacterium by high-fat blood plate and PCR, and to detect different methods by comparing with the detection rate of common blood plate. Results 1. Detection of Corynebacterium granulomatosus mastitis: 24 cases of pus samples were divided into two repetitions: normal blood plate culture, the positive rate was 16.7. The positive rate of Corynebacterium was increased by 33.3%. The difference was statistically significant (P = 0.014). (2) 44 pus samples were divided into two repetitions: the positive rate of Corynebacterium Corynebacterium was 36.4% and the positive rate of C.K. Corynebacterium was 31.2%. PCR detection was performed. The positive rate of Corynebacterium was 50.0% and that of C.K was 45.5%. There was no significant difference between them. P=0.197.2. The significance of detection of Corynebacterium granulomatosus for clinical medication was as follows: (1) The positive rate of Corynebacterium was 59.3%, the negative rate was 40.7%, and the positive rate of C.K Corynebacterium was 54.7%. Negative rate was 45.3%. (2) Antibiotic regimens for GM patients infected with Corynebacterium included short-acting levofloxacin and azithromycin, long-acting anti-mycobacterium triple drug. (3) Follow-up of 42 cases, 21 cases were positive for Corynebacterium by PCR, and the recurrence rate was 23.5%. The efficacy of the three regimens was poor among GM patients infected with corynebacterium. P = 0.036. (4) Follow-up 42 cases, PCR detection of Corynebacterium negative 21 cases, postoperative recurrence rate of 16.7%. There was no significant difference between the two groups of different treatments for non-bacterial infection of GM patients, P = 0.719. Conclusion High-fat blood plate bacterial culture and PCR detection method is reliable, rapid detection of GM patients pus club shape. The early detection of Corynebacterium infection in GM patients is of great significance for clinical application of lipophilic antibiotics.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R655.8
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相關期刊論文 前2條
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2 劉雙格;續(xù)哲莉;;人類乳腺炎性疾病細菌學研究[J];醫(yī)學綜述;2011年20期
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